Understanding the hemodynamic changes in fetuses with coarctation of the aorta using a lumped model of fetal circulation

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  • dc.contributor.author Villanueva-Baxarias, Inmaculada
  • dc.contributor.author Pellisé Tintoré, Anna
  • dc.contributor.author Pérez-Rodríguez, María-Teresa
  • dc.contributor.author Nogué, Laura
  • dc.contributor.author Vaziraani, Pooja
  • dc.contributor.author Soveral, Iris
  • dc.contributor.author Crispi Brillas, Fàtima
  • dc.contributor.author Gómez, Olga
  • dc.contributor.author García-Canadilla, Patricia
  • dc.contributor.author Camara, Oscar
  • dc.contributor.author Bijnens, Bart
  • dc.contributor.author Bernardino Perez, Gabriel
  • dc.date.accessioned 2025-10-20T06:16:20Z
  • dc.date.available 2025-10-20T06:16:20Z
  • dc.date.issued 2025
  • dc.description.abstract Coarctation of the aorta (CoA) is a common congenital heart defect characterized by aortic narrowing. Prenatally, it has mild hemodynamic effects as right ventricular disproportion and ductus arteriosus (DA) dilation occur as adaptive mechanisms, but their impact on CoA hemodynamics remains poorly understood. To investigate this, we built a closed 0D computational model of fetal circulation and simulated different CoA cardiovascular remodeling patterns, including aortic isthmus (AoI) narrowing, ventricular disproportion, and DA dilation. Our results showed mild AoI narrowing (80% of reference diameter) required up to 1.7 right/left ventricular end-diastolic volume ratio and 115% DA dilation to maintain physiological pressures, wall shear stresses, and organ perfusion. In contrast, severe narrowing (20% of reference AoI diameter) required up to 5 right/left ventricular end-diastolic volume ratio and 125% DA dilation, highlighting the necessity of co-occurrence of prenatal ventricular disproportion and DA dilation to compensate for AoI narrowing. These physiological regions were validated with ultrasonographic measurements from 7 controls and 9 CoA patients. We compared blood pressures, velocities, and volumetric flow rates across different fetoplacental anatomical sites. AoI velocity showed a delayed retrograde flow peak and increased antegrade diastolic velocity with greater AoI narrowing, which may aid in diagnosing CoA. Minimal differences were observed in other velocities and pressures. Volumetric flow rates across varying degrees of AoI narrowing decreased in the AoI and mitral and aortic valves, remained stable in the middle cerebral and umbilical arteries, and increased in the DA and tricuspid and pulmonary valves. Therefore, we corroborated that in fetal CoA a redistribution of blood flow occurs to ensure perfusion of the brain and placenta, without a significant alteration in fetal hemodynamics (blood pressure and velocities) except for increased diastolic velocities in the AoI.en
  • dc.description.sponsorship This work was supported by European Social Fund Plus (ESF+) and Generalitat de Catalunya (Joan Oró Grant 00237 to I.V.B.; Beatriu de Pinos Grant 2018-BP-00201 to P.G.C.), by the H2020 Marie Skłodowska-Curie Actions (Marie Skłodowska-Curie Grant 801370 to P.G.C), by ESF+ and Ministerio de Ciencia e Innovación (RYC2023-043724-I to P.G.C. and RYC2022-035960-I to G.B.), and by Fundació la Marató de TV3 (Project CoALeS 650/C/2020). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.en
  • dc.format.mimetype application/pdf
  • dc.identifier.citation Villanueva-Baxarias I, Pellisé-Tintoré A, Pérez-Rodríguez M, Nogué L, Vaziraani P, Soveral I, et al. Understanding the hemodynamic changes in fetuses with coarctation of the aorta using a lumped model of fetal circulation. PLoS Comput Biol. 2025 May 30;21(5):e1013096. DOI: 10.1371/journal.pcbi.1013096
  • dc.identifier.doi http://dx.doi.org/10.1371/journal.pcbi.1013096
  • dc.identifier.issn 1553-734X
  • dc.identifier.uri http://hdl.handle.net/10230/71546
  • dc.language.iso eng
  • dc.publisher Public Library of Science (PLoS)
  • dc.relation.ispartof PLoS Computacional Biology. 2025 May 30;21(5):e1013096
  • dc.relation.projectID info:eu-repo/grantAgreement/EC/H2020/801370
  • dc.rights © 2025 Villanueva-Baxarias et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by/4.0/
  • dc.subject.other Flux sanguinica
  • dc.subject.other Aortaca
  • dc.subject.other Hemodinàmicaca
  • dc.title Understanding the hemodynamic changes in fetuses with coarctation of the aorta using a lumped model of fetal circulationen
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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